RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2013-01889
BRANCH OF SERVICE:  Army	BOARD DATE:  20141022
SEPARATION DATE:  20050103

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a drilling Reservist SSG/E-6 (91P/X-Ray Technician) medically separated for a left knee and fibromyalgia (FM) conditions.  The knee and fibromyalgia could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards.  She was issued a permanent P3/L3 profile and referred for a Medical Evaluation Board (MEB).  The knee and FM conditions, characterized as “left knee chondromalcia” and “fibromyalgia,” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded six other conditions as medically acceptable.  The Informal PEB adjudicated “chronic pain due to chondromalacia of left knee” and “fibromyalgia syndrome” as unfitting, rated 10% and ---% (no rating assigned) respectively, citing the US Army Physical Disability Agency (USAPDA) pain policy for the knee and the VA Schedule for Rating Disabilities (VASRD).  It also referenced the FM, stating that “there is compelling evidence to support a finding that the current condition existed prior to service (EPTS) and was not permanently aggravated beyond natural progression by such service.”  The remaining six conditions were determined to be not unfitting.  The CI non-concurred with the PEB, forwarding a rebuttal in which she concurred with the 10% rating, but disputing the disability rating statements and stating that the fibromyalgia was not EPTS.  A USAPDA review upheld the PEB’s decision and medically separated the CI.

CI CONTENTION:  The CI writes: “My left knee has caused a life changing way of being.  The inflammation, pain causes my “illegible” walk and due to this it brought many alterations to my body which the VA will not take care of due to my medical discharge from the Army so they will not treat my Lt. knee.  Even so pain persisted for months and swelling has well.  It has being clothe wearing inconvenience due to wraps and braces that I’ve borrowed and to no help because of swelling and pain.  The 100% received in 2004 was temporary without the care of the Lt. knee (service connected) nclose [sic] is a copy of such evaluation (thank you) from the VA.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The ratings for the unfitting knee and FM conditions are addressed below.  No additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Service IPEB – Dated 20040520	VA - (2 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain due to Chondromalcia of L Knee	5099-5003	10%	Left Knee	5014	NSC	20041130	
Fibromyalgia Syndrome	5025	---%	Fibromyalgia	5025	40%	20041130	
PTSD	Not Unfitting	PTSD	9411	100%	20040706	
Other x 5 (Not in Scope)	Other x 0	20041130	
Combined:  10%	Combined:  100%	
Derived from VA Rating Decision (VARD) dated 20050310 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:  The Board acknowledges the CI’s sentiment regarding the significant impairment with which her service-connected condition continues to burden her; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board considers VA evidence proximate to separation in arriving at its recommendations; and, DoDI 6040.44 defines a 12-month interval for special consideration to post-separation evidence.  Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation.  The CI was on active status from 7 August 1979 to 6 January 1982 and 21 November 1990 to 14 June 1991.  It is not clear from the record when she was placed on incapacitation status, but the record suggests that she was in this status beginning in 2001 until separation.

Chronic Pain due to Chrondromalcia of Left Knee.  The CI was first seen for her left knee on 29 April 2001 after she injured it during a physical training run.  A magnetic resonance imaging (MRI) on 9 May 2001 showed no ligamentous or meniscal injury, but changes consistent with irritation of a tendon on the outside of the knee and mild degeneration of the knee cap.  Surgery for the latter was performed on 31 July 2001.  On examination (under anesthesia) she was found to have a stable knee without meniscal tear although the mobility of the outside (lateral) meniscus (cartilage cushion in the knee joint) was increased.  Degeneration of the cartilage of the knee joint was also noted and treated.  Rehabilitation after surgery was not successful in returning her to duty status.  A repeat MRI on 4 February 2002 showed a small amount of fluid and stable degenerative changes of the cartilage.  The ligaments and menisci remained unremarkable.  A bone scan was obtained on 22 April 2003 to evaluate for a neurological cause of her pain (reflex sympathetic dystrophy), but was negative for this.  Of note, although she showed activity in her left hip, skull and teeth, the knees were negative.  A knee X-ray performed on 6 July 2004 could not exclude a small loose body; however, this had not been seen on arthroscopy or the two prior MRIs.  On a 5 July 2004 internal medicine evaluation, the examiner documented that she could walk on her toes and also could tandem walk without difficulty.  The narrative summary was dated on 14 July 2003, almost 18 months prior to separation.  She reported pain 100% of the time.  On examination, she had pain of the kneecap without swelling (effusion) or instability.  The range-of-motion (ROM) was nearly normal at 0-130 degrees (0-140 is normal).  At the MEB examination on 18 March 2004, 10 months prior to separation, the CI reported that the left knee locked, gave out, swelled up and was associated with ligament pain.  The examiner noted a ROM of 0-110 degrees.  There is no VA Compensation and Pension examination in the record for the knee condition.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated the left knee at 10% using the USAPDA pain policy and coding it 5003 for degenerative arthritis.  The VA found the knee pain to have its onset in 2001 in a period in which she was not activated.  It was determined to be non-service-connected and no rating assigned.  This adjudication stood on later VARDs.  The Board considered the findings.  The loss of ROM is non-compensable.  Motion was painful warranting a 10% rating under VASRD §4.59 (painful motion).  There was no instability or meniscal pathology.  The Board determined that there was no route to a rating higher than the 10% adjudicated by the PEB.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left knee condition.

Fibromyalgia. The CI was evaluated by rheumatology in April 2003 and given the diagnosis of diffuse myofascial pain syndrome as she did not meet the diagnostic criteria for FM syndrome (FMS) at that time.  She was re-evaluated on 30 July 2003 and reported a worsening of her symptoms.  She met the criteria of FMS at this appointment and the diagnosis was made.  She was noted to be under poor control.  Consideration of separation for this condition was recommended.  The PEB determined that the condition was unfitting, but that it was EPTS as the condition developed and was diagnosed when she was not on active duty.  In fact, she appeared to be in an incapacitation status.  The condition did not develop while on active duty nor as a result of her drill status.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication of EPTS.  Accordingly, this condition cannot be recommended for an additional disability rating.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  As discussed above, PEB reliance on the USAPDA pain policy for rating the left knee was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the left knee condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended FM condition, the Board unanimously agrees that it cannot recommend it for additional disability rating.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131016, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

				

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXX, AR20150006964 (PD201301889)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						     
						         
CF: 
(  ) DoD PDBR
(  ) DVA